Cygnet Fountains

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that patients’ care, treatment and support achieved good
outcomes and promoted a good quality of life, based on best available evidence. At our last
assessment we rated this key question as outstanding. At this assessment the rating has changed to
requires improvement. This meant patient’s outcomes were not consistently positive.
Occupational therapy input, including goals for recovery and participation, was not always evident in
all patient care plans. It was not always clear what activities the patient was offered/engaging in or
what skills they were developing to prepare for discharge. There were very few activities at the
weekend, and it was not clear that patients needs in relation to education and work opportunities
were always considered or documented.
The service was in breach of regulations as care and/or treatment was not designed with a view to
achieving service users’ preferences and ensuring their needs were met.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

The effectiveness of people’s care and treatment was not maximised due to concerns in relation to the assessment and review of their health, care, wellbeing and communication needs.

We reviewed 4 care records during the assessment and case tracked 4 patient records to review evidence of progress through the rehabilitation pathway.

Staff completed a comprehensive mental health assessment of the patient in a timely manner at, or soon after, admission. All records we reviewed contained comprehensive assessments.

However, care plans were not consistently personalised, holistic and recovery oriented and did not always meet the needs identified in the patient’s assessment. Two of the care plans we reviewed lacked occupational therapy input and did not contain goals for recovery and rehabilitation. Another care plan did not specify what activities the patient was offered/ engaging in or what skills they were developing to prepare for discharge. For example, goals and subsequent activities for one patient who was further on in their recovery journey focused on gym exercises with little evidence of any other skill promotion. In the four records we reviewed there was little or no evidence of exploration of education and/or employment and self-management of medicines was either not explored or not documented effectively. Staff explained that these patients were either in the early stages of rehabilitation and not able to fully engage yet or were at the end of completing the rehabilitation pathway and had little else to complete. It was unclear how these patients needs were being met within a rehabilitation setting.

Since the inspection, 5 further patient care plans, including therapy notes, were shared with the inspection team. Whilst these did evidence clearer occupational therapy goals, there was still a lack of exploration in relation to education or employment for these patients.

Staff assessed patients’ physical health needs in a timely manner after admission. Physical health was assessed during the admission process. There were monthly physical health clinics to ensure ongoing physical health care was maintained.

There were problems with planning and delivering patients’ care and treatment with them, including what is important and matters to them and in line with legislation and current evidence-based good practice and standards.

The service had the resources to deliver a range of care and treatment interventions suitable for the service. However, we were concerned, and staff told us, that some patients were unable to participate in activities due to their level of acuity. Additionally, ten patients had completed their rehabilitation pathway and were awaiting external placements with ongoing therapeutic support provided during this period.

Reasons given for the delayed discharge of these patients were mostly around waiting for new placements and funding to be agreed. One patient was awaiting admission to an acute ward, and another was being assessed for autism with a potential move to a learning disability/ autism ward.

The interventions provided to those able to access them were those recommended by, and were delivered in line with, guidance from the National Institute for Health and Care Excellence. These included medicine and psychological therapies. There was a rehabilitation model of care which consisted of:

• Stage 1, assessment and engagement
• Stage 2, recovery
• Stage 3, consolidation
• Stage 4, transition and discharge

There was an activities timetable and individual activities. Activities included cooking groups, exercise groups and shopping trips. However, activities were not always well attended. The service had the staffing and environmental resources to deliver a targeted and personalised activity programme. However, patients did not always attend due to their level of acuity or feeling disengaged. Many of the patient were at either stage one or stage 4 with few in stages 2 or 3 which meant they were actively engaging. There were also very few activities at the weekend. The established occupational health staff had contractual terms and conditions to work Monday to Friday only. One new staff member worked alternate Saturdays. There was an advert out to recruit new staff to work on weekends to deliver activities. In the meantime, ward staff delivered some ward-based activities at weekends but this was dependant on whether staff had the time to do this amongst their other duties. Some staff commented that there were not enough activities for patients to engage in unless they had section 17 leave and could access the local community to find their own opportunities.

Psychology based groups included, mental health awareness, improving mental health, mental health relapse and deciding your future.

The psychology team could deliver therapies such as cognitive behavioural therapy, acceptance and commitment therapy, compassion focussed therapy and eye movement desensitisation and reprocessing therapy.

The psychology team produced a monthly patient psychology newsletter to help engage patients with the psychology programme and to share information. The service attempted to utilise social inclusion projects such as fundraising, charity work, summer funday and pride events.

At the time of the inspection there were no patients engaged in training or work opportunities in the community. However, the service provided a range of internal and socially inclusive activities aligned with the rehabilitation principles, with plans to extend community engagement as individual readiness increased.

Staff ensured that patients had good access to physical healthcare, including access to specialists when needed. Physical health was assessed on admission. Patients had the choice to keep their own GP or dentist or move to the local GP or dentist. There was a physical health lead who could review each patient monthly and conducted specific assessments around falls risks, eyesight, hearing, blood tests, urine screen and ECG’s. The physical health lead could link in with the GP and secondary care services as required. The service had a doctor who could also review patient information and offer advice and treatment. The service had noted a delay in accessing physical health results and information from GP’s and hospitals. They were in the process of setting up access to NHS patient accounts to make this process faster.

Staff mostly assessed and met patients’ needs for food and drink and for specialist nutrition and hydration. However, one patient had diet and fluid charts in place, but the information was difficult to understand. The chart gave no clear evidence of the total diet and fluid in 24 hours. The format of the chart meant that it was difficult to complete and then the information was not clear.

Staff participated in clinical audit, benchmarking and quality improvement initiatives. The service benchmarked itself with another similar service run by the provider. The service had also begun to benchmark themselves against the accreditation for inpatient mental health services (AIMS), accreditation scheme. The service planned to create quality improvement initiatives following the outcome of the AIMS accreditation.

The team mostly included or had access to the full range of specialists required to meet the needs of patients in the service. The service had the following MDT staff; 1 Lead psychologist, 2 assistant psychologists, 1 specialist occupational therapist, 1 occupational therapist, 1 occupational therapy assistant, 3 therapy coordinators, 1 responsible clinician and 1 speciality doctor. It had been identified that more staff were required to ensure sufficient activities could be provided 7 days a week.

The service had weekly visits from an internal peer support worker who attended to review the quality of the service. They were an ex-patient who had previously been an inpatient. They visited to speak with patients and staff and observed interactions and then gave feedback to the registered manager. The registered manager was considering employing a social worker to compliment the MDT and to support the discharge planning process.

Staff were experienced and qualified and had the right skills and knowledge to meet the needs of the patient group.

Staff would work supernumerary initially for 2 weeks. During this 2-week period they would be expected to complete all training and be shown the ward and the location of emergency equipment and other pertinent information. Agency staff all received a local induction and there was a record of this being completed. There was an induction and learning policy for staff to follow.

Managers provided staff with supervision and appraisal of their work performance. Staff met monthly for clinical supervision. Clinical supervision rates for the last 12 months were 88%.

Managers ensured that staff had access to regular team meetings. There was evidence of staff making suggestions for new ideas and improvement and these being acted upon. This included team building exercises and employee of the month. The meeting also included compliments to staff for working hard, and areas for improvement.

The percentage of clinical staff that had had an appraisal or begun an appraisal in the last 12 months was 81%.

Managers identified the learning needs of staff and provided them with opportunities to develop their skills and knowledge. A healthcare assistant had recently qualified as a nurse after completing a nurse apprenticeship course funded by the provider.

Managers ensured that staff received the necessary specialist training for their roles. A new face to face learning disability training course was due to be rolled out. Staff had received specialist training for their roles which included extra specific training in areas such as equality and diversity, freedom to speak up, staff involvement, autism, personality disorder, ADHD and epilepsy.

Managers dealt with poor staff performance promptly and effectively. The registered manager was able to describe instances of dismissing staff due to concerns such a serious medicines error, and also gave examples of addressing poor staff performance by using the internal HR processes.

We work effectively across teams and services to support patients, making sure they only need to tell their story once by sharing their assessment of needs when they move between different services.

Staff held regular and effective MDT team meetings. There was a daily morning meeting in place attended by all MDT staff and the registered manager. Housekeeping and catering staff also attended the meeting for the first part that related to patient risks and environmental issues. The meeting covered staffing and emergency response cover. Each patients’ needs were discussed and actions assigned to individual staff to complete. Care plans and risk assessments were reviewed to ensure updates had occurred. There were opportunities for staff of all disciplines to contribute to the discussions. Views and opinions were valued and respected.

Patients had weekly ward rounds where they could contribute to their care and have a voice.

There were monthly staff reflective group meetings in place, led by managers. We reviewed the meeting minutes and saw this contained a clear agenda with identified actions. There was a separate domestic team meeting to discuss in more detail domestic issues.

Staff shared information about patients at effective handover meetings within the team.

The service had effective working relationships with teams outside the organisation including strong links with the local GP surgery. Staff were developing links with local authority housing departments and supported accommodation to support patients’ discharge but this was in its’ infancy and so we could not yet see any potential impact of this.

We support Patients to manage their health and wellbeing so they can maximise their independence, choice and control, live healthier lives and where possible, reduce their future needs for care and support.

Staff supported patients to live healthier lives. The service was due to become a smokefree site in September 2025. In preparation for this smoking cessation groups had been arranged. Medical staff could prescribe nicotine replacement patches and lozenges for patients.

Ward activities helped promote a healthy lifestyle for patients. There were 7 weekly group activities that involved food preparation, including cooked breakfast group, baking and smoothie making. There were 6 weekly group activities that involved exercise such as walking groups, gym sessions and a martial art class.

One patient had suggested that an outdoor gym would be beneficial and funding for this had been applied for. A diet club was in the process of being set up to encourage healthy eating and exercise.

We routinely monitor patients’ care and treatment to continuously improve it and to ensure that outcomes are positive and consistent, and that they meet both clinical expectations and the expectations of Patients themselves.

Staff used recognised rating scales to assess and record severity and outcomes. These included, Liverpool University Neuroleptic Side Effect Rating Scale, Positive and Negative Syndrome Scale, depression rating scale and health of the nation outcome scores.

Staff used technology to support patients effectively. There was a longer plan for prompt access to blood test results via the NHS online system.

The occupational therapy team had recently requested electronic tablets to support individual therapy sessions and managers confirmed these had been ordered.

We tell Patients about their rights around consent and respect these when we deliver person-centred care and treatment.

Staff took all practical steps to enable patients to make their own decisions.

For patients who might have impaired mental capacity, staff assessed and recorded capacity to consent appropriately. Capacity was clearly recorded in patient notes.

Staff considered patient’s capacity on a decision-specific basis with regard to significant decisions.

When patients lacked capacity, staff made decisions in their best interests, recognising the importance of the person’s wishes, feelings, culture and history.